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Statins don’t work in people who have never had a heart attack. Your risk of heart attacks goes down by a small amount, but you don’t live any longer. (Woe be unto those who repeat this finding. In 2011 the Cochrane Review — sort of the supreme court for determining what works in medicine — agreed that statins don’t help the healthy. But after coming under intense pressure for saying so, this year they reversed themselves.)
By dispensing statins en masse, we not only spend billions on unnecessary drugs, we expose millions of healthy Americans to a host of side effects whose magnitude have been downplayed thanks to trials that don’t look very hard for bad news.
Statins do lower your LDL, or so-called “bad” cholesterol. So why don’t they work? LDL comes in many forms, only the smallest of which predict heart disease. And as pioneering LDL researcher Ronald Krauss, M.D., will tell you, “they disproportionately reduce the large forms of LDL” (the kind that don’t hurt you).
“It has been a convenient story that changing risk markers will change risk,” says Harlan Krumholz, M.D., the Yale researcher Medtronic recently hired to tell them their spine plug known as Infuse had been oversold. “But it’s just not that simple.” Blaming LDL for heart disease may be like blaming fire trucks for fires.
Those details were lost in the excitement last month over the newest effort to reduce LDL (“New tool to cut cholesterol: Mutation set off a medical chase for a better weapon to fight heart disease,” July 10). Written like a medical thriller for the biotech-curious, the piece by the New York Times’ Gina Kolata described how three companies are engaged in a “fevered race” to test an antibody that mimics in patients a rare genetic mutation of a protein known as PCSK9, a mutation that lowers LDL.
In just two people identified with the mutation the world over — a mutation with heart benefits that separated according to race — LDL was so low it looked like a misprint (15, when numbers over 100 are normal). Kolata floated images of an injectable that might one day be taken in pill form by one out of every four adults.
The story ran on the Times’ (and Star Tribune’s) front page, and follow-up reporting in the biotech press speculated about revenue streams of a size that would only be of interest to hedge funders and others who make a living pouring gas into the engine of wealth concentration.
“If I had coronary disease,” a researcher paid by one of the drugmakers was quoted as saying, “I would definitely try to drive my LDL to well below 50.”
Good to know what someone paid to be excited about the project thinks.
Krauss, meanwhile, believes very low LDL could scoop up the worst forms of LDL, but what that means is still unknown. Krumholz says that until trials are concluded, “it is just an unknown.”
Given that we already spend so much on drugs that do so little, perhaps we should think harder about how we greet the latest biotech adventure tale. We could start by not encouraging journalists who describe low LDL numbers as “dazzling,” or who call a Pharma money chase “one of the greatest medical chases ever.”
Following that splash, I managed to descend into a joyless if polite Twitter war with a nice enough biotech blogger who had chronicled much of the story, like the writer at the Times, in terms of what it might mean for the drugmakers’ financial prospects. Maybe that was not fair. LDL-lowering drugs are perfect for stock pickers. Like the latest jobs numbers, LDL is a simple numeric taken as a shorthand for a complex system. Picking stocks has had as little to do with our economic health as moving LDL has had to do with our physical health.
In this way, the PCSK9 story is great fun for the gallery, but maybe just a fancier form of reality TV: captivating, dumb, probably harmful. Any time the health media start telling us to grab a bag of popcorn and pull up a chair because the guys at Sanofi, Pfizer and Amgen are close to landing a big one, we should know where this is heading.
A guy who takes a pill, jumping off a dock with a chocolate lab — when all he really needed was the lake and the dog.
Paul John Scott is a health sciences writer living in Rochester. On Twitter: @pauljohnscott1.
The Opinion section is produced by the Editorial Department to foster discussion about key issues. The Editorial Board represents the institutional voice of the Star Tribune and operates independently of the newsroom.